Provider Demographics
NPI:1114199379
Name:LANGDON, MICHAEL JON (RPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JON
Last Name:LANGDON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44444-1272
Mailing Address - Country:US
Mailing Address - Phone:330-872-4442
Mailing Address - Fax:330-872-0521
Practice Address - Street 1:325 W BROAD ST
Practice Address - Street 2:
Practice Address - City:NEWTON FALLS
Practice Address - State:OH
Practice Address - Zip Code:44444-1272
Practice Address - Country:US
Practice Address - Phone:330-872-4442
Practice Address - Fax:330-872-0521
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-22840183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist